Primary Care Doctors: Finding a Top One

Here are questions you should consider in looking for a primary care doctor. A top primary care doctor is a vital element in your plan to stay safe and healthy in our fragmented health care system.

1. First, is the doctor board certified in either internal medicine or family practice? (Or pediatrics, if you are shopping for a child.) This certification means the doctor has sat for a rigorous multiday written test. And the boards that administer these tests are now requiring doctors to be retested every dozen years or so to keep their certifications. (Older doctors don’t have to undergo recertification.) You will see the certificate on the office wall, or you can just call the office and ask, or you can check online here.
   Warning: Besides the twenty-four specialties (and more than a hundred subspecialties) approved and certified by the American Board of Medical Specialties, there are other specialty “boards” that may have far less rigorous requirements. It’s a free country; any group of doctors can get together, come up with a name, call themselves the American Board of XYZ, and declare that anyone who pays annual dues and shows up for meetings in nice resorts is certified by their board. So don’t just ask if your doctor is board certified, ask, “Board certified in what?” There’s nothing necessarily wrong with a doctor having one of these less traditional board certifications, but if that’s all she has, a large red flag should go up in your mind. The ABMS Web site can tell you if a doctor is certified by any of its twenty-four boards. Note: Osteopathic physicians (DO) have their own certifying boards, and they are as rigorously trained as MDs.
2. Second, is the doctor subcertified in a specialty board for your medical issue? If you are in absolutely perfect health, this question doesn’t apply, and in fact, you may be better off with a generalist who doesn’t have any specialty focus, because you are seeing him for his diagnostic, big-picture skills. But if you have any kind of long-term issue that falls in the domain of one of the subboards under internal medicine, you would be well advised to find a doctor in that specialty. There are eighteen subspeciality certificates issued by the American Board of Internal Medicine (ABIM), from familiar ones like cardiology, rheumatology (arthritis), geriatrics, and endocrinology (diabetes), to less well-known ones, like sleep medicine. (You can see the full list at the ABIM Web site.) Now, many board-certified internists who do not have one of these specialty boards will still regularly see patients in these domains, so this is not a hard-and-fast rule. But when your issue is management of a long-term problem, you’re usually better off with a specialist in that problem.
3. Third, find out how accessible the doctor is outside of scheduled appointments. What is the system? Does she respond to e-mail? Are you expected to talk to a nurse first? (Not necessarily a bad thing, I should add; you just need to know the system.) After hours, would the callback come from the doctor personally or from some backup doctor who may know nothing about you?
4. Fourth, and this is especially important for a primary-care doctor, how well does he listen to you? Are you discouraged or frustrated after a visit? If so, it’s time to move on. But note also, this is item four on our checklist, not item one. It’s a big mistake to put communications skills ahead of basic training. The medical knowledge has to come first.
5. Fifth, does the doctor show some compassion and empathy for you, without being condescending? Cold care is bad care. Even if the care is technically proficient, you need to see someone with whom you have some emotional connection, because trust and confidence help the therapeutic relationship as much as any technical know-how. For one thing, a good relationship encourages you to follow the doctor’s advice. If you leave the doctor’s office feeling stupid or that you’ve wasted her time, that doctor is not for you. At the same time, you want to be treated like a grown-up.
6. Sixth, does the doctor address what really scares you, even if you haven’t fully put it into words? People often go to the doctor out of fear. You might be having recurring headaches. You mention the headaches, but you don’t mention that you’re really worried about brain cancer or a blood vessel in your head bursting open. Any doctor who doesn’t have the sense to realize that you’re not there just to be told to pick up some over-the-counter headache pills is not for you.
7. Finally, how up-to-date is the doctor’s office with electronic records? If you can read your own records on-line and get test results the same way, that’s a big leap forward in educating yourself and preventing communication errors.